Controlled Oxygenated Rewarming and Subnormothermic Machine Perfusion of Steatotic Livers: First Clinical Results.
1General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
2Institute of Physiological Chemistry, University Hospital Essen, Essen, Germany.
Meeting: 2016 American Transplant Congress
Abstract number: 496
Keywords: Liver preservation, Machine preservation
Session Information
Session Name: Concurrent Session: Ischemia Reperfusion Injury: Clinical Innovation
Session Type: Concurrent Session
Date: Tuesday, June 14, 2016
Session Time: 4:30pm-6:00pm
Presentation Time: 4:30pm-4:42pm
Location: Room 311
Introduction
Controlled oxygenated rewarming (COR) of cold stored livers by machine perfusion demonstrated convincing results in the first clinical pilot series (1). Here we report on the extension of this new endischemic reconditioning concept for steatotic donor livers.
Methods
Between 03/2015 and 06/2015 eight distally procured livers from DBD-donors, which had been rejected by other transplant centers and had a minimal steatosis of 30% were subjected to the COR protocol before transplantation. Steatosis was assessed by histology. Immediately after arrival in our transplant center the hepatic artery and portal vein were cannulated. Gentle rewarming of the graft was effectuated thereafter by pressure controlled oxygenated machine perfusion (MP) via portal vein and hepatic artery (Organ Assist, Groningen, NL) while gradually increasing perfusate temperature up to 20[deg]C. Custodiol-N was used as preservation solution. Real-time biochemical analysis of perfusate parameters was carried out in constant time intervals during the controlled rewarming.
Results
Donor age was 60 (50-71) years, ischemic times were 7.6 (6.7-13.5) hours and the DRI was 2.1 (1.6-2.5). 2 out of 8 organs were not transplanted due to the macroscopic appearance and the overall risk profile.
Recipients (3m/ 3f) had a median age of 58 (44-65) years and a labMELD of 12 (9-21). 2 out of 6 patients experienced early allograft dysfunction. The mean peak aminotransferase (AST) levels within the first 7 days was 1812.8 (535-1866) U/l.
The two discarded livers demonstrated during the machine perfusion period a continuous release of aminotransferases and the highest peak values in the perfusate (8542 U/l & 5186 U/l). A significant correlation (r2=0.8; p<0.05) was observed for the AST release into the perfusate with the postoperative aminotransferase peak. After minimum follow-up of 5 months after transplantation, all recipients are alive with excellent graft function.
Conclusions
This first clinical application of COR by machine perfusion for steatotic donor livers demonstrated feasibility and safety. Correlation of early available perfusion characteristics seems to be a promising new tool to decrease discard rates of steatotic organs.
References
1. Hoyer et al. Transplantation. 2015 Oct 16. [Epub ahead of print].
CITATION INFORMATION: Hoyer D, Gallinat A, Treckmann J, Benkoe T, Swoboda S, Rauen U, Paul A, Minor T. Controlled Oxygenated Rewarming and Subnormothermic Machine Perfusion of Steatotic Livers: First Clinical Results. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Hoyer D, Gallinat A, Treckmann J, Benkoe T, Swoboda S, Rauen U, Paul A, Minor T. Controlled Oxygenated Rewarming and Subnormothermic Machine Perfusion of Steatotic Livers: First Clinical Results. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/controlled-oxygenated-rewarming-and-subnormothermic-machine-perfusion-of-steatotic-livers-first-clinical-results/. Accessed May 21, 2025.« Back to 2016 American Transplant Congress